Сравнительная оценка прогностической ценности самостоятельного и врачебного забора материала для ВПЧ-теста
Сравнительная оценка прогностической ценности самостоятельного и врачебного забора материала для ВПЧ-теста
Белокриницкая Т.Е., Туранова О.В., Фролова Н.И. Сравнительная оценка прогностической ценности самостоятельного и врачебного забора
материала для ВПЧ-теста. Гинекология. 2018; 20 (2): 51–54.
DOI: 10.26442/2079-5696_2018.2.51-54
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Belokrinitskaya T.E., Turanova O.V., Frolova N.I. Purpose of the study. Evaluate the prognostic value of an independent and medical fence of the vaginal
discharge for the HPV test. Gynecology. 2018; 20 (2): 51–54.
DOI: 10.26442/2079-5696_2018.2.51-54
Сравнительная оценка прогностической ценности самостоятельного и врачебного забора материала для ВПЧ-теста
Белокриницкая Т.Е., Туранова О.В., Фролова Н.И. Сравнительная оценка прогностической ценности самостоятельного и врачебного забора
материала для ВПЧ-теста. Гинекология. 2018; 20 (2): 51–54.
DOI: 10.26442/2079-5696_2018.2.51-54
________________________________________________
Belokrinitskaya T.E., Turanova O.V., Frolova N.I. Purpose of the study. Evaluate the prognostic value of an independent and medical fence of the vaginal
discharge for the HPV test. Gynecology. 2018; 20 (2): 51–54.
DOI: 10.26442/2079-5696_2018.2.51-54
Цель исследования. Оценить прогностическую ценность самостоятельного и врачебного забора вагинального отделяемого для ВПЧ-теста. Материалы и методы. В исследование вошли 200 женщин в возрасте 18–45 лет (средний возраст 32,7±6,9 года), которым было выполнено традиционное цитологическое исследование и тестирование на вирус папилломы человека (ВПЧ) высокого канцерогенного риска (ВКР). Забор вагинального секрета для идентификации ДНК ВПЧ методом полимеразной цепной реакции выполнялся самостоятельно женщиной с помощью прибора «Qvintip» и врачом – из цервикального канала. Прогностическая ценность этих методик оценивалась по общепринятым формулам. Результаты. ВПЧ ВКР выявлен у 42% обследованных. Наиболее распространенными типами были ВПЧ-16 (17,7%), ВПЧ-56 (16,3%), ВПЧ-39 (13,6%). У 51,2% ВПЧ-положительных женщин отмечалось сочетание нескольких типов ВПЧ ВКР. Результативность обследования с помощью устройства «Qvintip» была выше, чем при заборе материала врачом: 38% vs 27,5% (отношение шансов – ОШ=1,6; 95% доверительный интервал – ДИ 0,48–2,45; χ2=5,0, pχ2=0,025). Устройство «Qvintip» выявляло ВПЧ ВКР в 5 раз чаще: 34,5% vs 9,5% (ОШ=5,0; 95% ДИ 1,61–6,71; χ2=15,3, pχ2=0,0001). Аномальная цитологическая картина выявлена только у ВПЧ-позитивных женщин в 17,9% (χ2=19,9, pχ2=0,0005), из них LSIL обнаружены в 15,5% случаев, HSIL – в 2,4%. Сравнительная оценка прогностической ценности выявила более высокую чувствительность метода самозабора (100%) по сравнению с врачебным забором материала (66,7%). Выявлена высокая специфичность обеих методик приготовления образцов для ВПЧ-теста: 65% – для самостоятельного и 72% – для врачебного. Заключение. Устройство «Qvintip» для самостоятельного забора вагинального отделяемого для ВПЧ-теста обладает высокой прогностической ценностью и может быть рекомендовано в качестве альтернативного метода при скрининге рака шейки матки.
Ключевые слова: вирус папилломы человека высокого канцерогенного риска, ВПЧ-тест, шейка матки, самозабор, «Qvintip», прогностическая ценность.
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The aim of the study is to assess the prognostic value of self-and medical sampling of vaginal discharge for HPV test. Materials and methods. The study included 200 women aged 18–45 years (mean age 32.7±6.9 years) who underwent traditional cytological testing and testing for HPV-stimulated stimulation. The vaginal secretion for the identification of HPV DNA by polymerase chain reaction (PCR) was performed by a woman alone using a Qvintip device and a doctor from the cervical canal. The predictive value of these techniques was evaluated according to generally accepted formulas. Results. 42% of those surveyed had HPV-stimulated stimulation. The most common types were HPV-16 (17.7%), HPV-56 (16.3%), HPV-39 (13.6%). 51.2% of HPV-positive women had a combination of several types of HPV-stimulated stimulation. The effectiveness of the examination with the Qvintip device was higher than when the doctor took the material: 38% vs 27.5% (OR=1.6, 95% CI 0.48–2.45, χ2=5.0, pχ2=0.025). The Qvintip device detected a 5-fold increase in HPV-SRV: 34.5% vs 9.5% (OR=5.0, 95% CI 1.61–6.71, χ2=15.3, pχ2=0.0001). An abnormal cytological picture was found only in HPV-positive women in 17.9% (χ2=19.9, pχ2=0.0005), of which LSIL were detected in 15.5% of cases, HSIL-2.4%. A comparative assessment of prognostic value revealed a higher sensitivity of the self-sampling method (100%) compared with the medical fence of the material (66.7%). High specificity of both methods of preparation of samples for HPV-test was revealed: 65% for independent and 72% for medical. The conclusion. The Qvintip device for self-sampling vaginal discharge for the HPV test has a high predictive value and can be recommended as an alternative method for screening cervical cancer.
Key words: human papillomavirus high carcinogenic risk, HPV test, cervix, sampling, Qvintip, prognostic value.
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1. Bruni L, Barrionuevo-Rosas L, Albero G et al. ICO Information Centre on HPV and Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in the World. Summary Report 2016.
2. Comprehensive Cervical Cancer Control. A guide to essential practice Second edition. World Health Organization, 2014.
3. Del Mistro A, Frayle H, Ferro A et al. Efficacy of self-sampling in promoting participation to cervical cancer screening also in subsequent round. Prev Med Rep 2016; 5: 166–68. DOI: 10.1016/j.pmedr.2016.12.017. eCollection 2017
4. Bosch FX, Broker TR, Forman D et al. Comprehensive control of human papillomavirus infections and related diseases. Vaccine 2013; 31 (Suppl. 7): H1–31.
5. Sukhikh G.T., Prilepskaia V.N. Profilaktika raka sheiki matki: rukovodstvo dlia vrachei. Izd. 3-e. M.: MEDpress-inform, 2012. [in Russian]
6. Lorincz A, Castanon A, Wey Wey Lim A, Sasieni P. New Strategies for HPV-based Cervical Screening. Wom Health (Lond Engl) 2013; 9 (5): 10. DOI: 10.2217/whe.13.48 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3880859/
7. Deleré Y, Schuster M, Vartazarowa E et al. Cervicovaginal Self-Sampling Is a Reliable Method for Determination of Prevalence of Human Papillomavirus Genotypes in Women Aged 20 to 30 Years. J Clin Microbiol 2011; 49 (10): 3519–22.
8. СDC. Cervical cancer is preventable 2014. http://www.cdc.gov/vitalsigns/cervical-cancer
9. Rogovskaia S.I. Prakticheskaia kol'poskopiia. Izd. 4-e. M.: GEOTAR-Media, 2016. [in Russian]
10. Belokrinitskaia T.E., Frolova N.I., Turanova O.V. i dr. Samostoiatel'nyi vs vrachebnyi zabor materiala dlia VPCh-testa: rezul'tativnost' i priemlemost' u patsientok raznykh vozrastnykh grupp. Doktor Ru. 2017; 7 (136): 8–14. [in Russian]
11. Shaniqua L, Jeanne MF. Update on prevention and screening of cervical cancer. World J Clin Oncol 2014; 5 (4): 744–52. DOI: 10.5306/wjco.v5.i4.744
12. Kisin V.I. Infektsii, peredavaemye polovym putem. Protokoly vedeniia bol'nykh. M.: N'iudiamed, 2014. [in Russian]
13. WHO guidance note: comprehensive cervical cancer prevention and control: a healthier future for girls and women. World Health Organization, 2013.
14. Wright TC, Stoler MH, Behrens CM et al. Primary cervical cancer screening with human papillomavirus: end of study results from the ATHENA study using HPV as the first-line screening test. Gynecol Oncol 2015;136 (2): 189–97.
15. Katki HA, Kinney WK, Fetterman B et al. Cervical Cancer Risk for 330,000 Women Undergoing Concurrent HPV Testing and Cervical Cytology in Routine Clinical Practice at a Large Managed Care Organization. Lancet Oncol 2011; 12 (7): 663–72.
16. Chen K, Ouyang Y, Hillemanns P, Jentschke M. Excellent analytical and clinical performance of a dry self-sampling device for human papillomavirus detection in an urban Chinese referral population. J Obstet Gynaecol Res 2016; 42 (12): 1839–45. DOI: 10.1111/jog.13132. Epub 2016 Sep 20.
17. Jentschke M, Chen K, Arbyn M et al. Direct comparison of two vaginal self-sampling devices for the detection of human papillomavirus infections. J Clin Virol 2016; 82: 46–50. DOI: 10.1016/j.jcv.2016.06.016. Epub 2016 Jun 28.
18. Bhatla N, Dar L, Patro AR et al. Can human papillomavirus DNA testing of self-collected vaginal samples compare with physician-collected cervical samples and cytology for cervical cancer screening in developing countries? Cancer Epidemiol 2009; 33 (6): 446–50.
19. Szarewski A, Cadman L, Mallett S et al. Human papillomavirus testing by self-sampling: assessment of accuracy in an unsupervised clinical setting. J Med Screen 2007; 14 (1): 34–42.
Авторы
Т.Е.Белокриницкая*, О.В.Туранова, Н.И.Фролова
ФГБОУ ВО «Читинская государственная медицинская академия» Минздрава России. 672000, Россия, Чита, ул. Горького, д. 39а
*tanbell24@mail.ru
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T.E.Belokrinitskaya*, O.V.Turanova, N.I.Frolova
Chita State Medical Academy of the Ministry of Health of the Russian Federation. 672000, Russian Federation, Chita, ul. Gor'kogo, d. 39a
*tanbell24@mail.ru